PROJECT SUMMARY Chronic pulmonary diseases coupled with environmental exposures present a growing public health problem in Peru, and globally. Indoor and outdoor air pollution, tobacco smoke and occupational fumes and exposures all contribute to burden of chronic respiratory disease in Peru. Social factors such a low socioeconomic status and gender further compound this exposure risk. For instance, in high altitude communities in the Andes, approximately 10% of adults are living with chronic obstructive pulmonary disease (COPD), affecting primarily women. Household air pollution, a major risk factor for COPD, is common in poor rural households where biomass fuels are used for cooking and accounts for over half (55%) of COPD cases in women in Peruvian highland communities. Noting these risks and increased exposure, there is an ever-growing need for research to address the causes and develop interventions to combat the environmental exposures driving the chronic pulmonary disease epidemic in Peru. This application for the NIH D43 Training Grant, a collaboration between William Checkley, MD, PhD at Johns Hopkins University in Baltimore, MD and Stella Hartinger, PhD at Universidad Peruana Cayetano Heredia in Lima, Peru, leverages 30 years of collaborations between our institutions to build a training and research program for promising, young Peruvian research scientists and health professionals. This cohort will have the opportunity to focus on environmental health and chronic pulmonary disease research with the mentorship and support of international, renowned faculty and advisors within environmental and pulmonary research, ranging from atmospheric scientists to implementation researchers. The program will provide intensive training opportunities and build training capacity in the range of scientific disciplines (clinical epidemiology, exposure assessment, efficacy trials, implementation science) relevant to addressing environmental exposure and pulmonary disease research at the masters, PhD and post-doctoral levels. The proposed training program will provide support to two doctoral students from Peru at JHBSPH and five master?s degree students at UPCH over the five-year award period and we will support five Peruvian postdoctoral fellows in their applications to the UJMT Global Fogarty Health Fellows program (JHU PD: Checkley). The long-term goal of this program is to build a sustainable and collaborative research-training infrastructure to support the generation of evidence for the effectiveness of complex interventions to address these health issues, as well as the translation of this evidence to policy and public health practice in Peru. This application is responsive to partnering institutions of PAR-18-901 including the Fogarty International Center and the National Institutes of Environmental Health Sciences through its focus on chronic pulmonary diseases and environmental exposures.